Comorbidities, Comedications and Polypharmacy among People Living with HIV and Associated Challenges with HIV Antiretroviral Therapy: Findings from People Living with HIV in Four Countries in Western Europe

Introduction We examined comorbidities, comedications and polypharmacy among people living with HIV (PLHIV) and associated challenges with HIV antiretroviral therapy (ART). Methods A cross-sectional design was used in web-based surveys conducted during 2019 in France, Germany, Italy, and the UK. Pooled sample comprised 120 internists/infectious disease specialists managing ≥50 HIV patients, and 1171 adult PLHIV combined who participated in two separate surveys, the Positive Perspective Survey (n=483), and the Unmet Needs Survey (n=688). The outcomes were perceptions and behaviors towards ART based on PLHIV and healthcare provider (HCP) perspectives. Results According to HIV physicians, challenges associated with comedications were a major reason for their patients not starting ART, or stopping, switching, or skipping their HIV treatment after they started. In total, 16.8% of providers indicated that their patients had not started ART because of medical reasons/comorbidities that interfered with dosing (France 21.7%, Germany 15.4%, Italy 6.9%, and UK 24.1%). Other reasons cited by providers for patients not starting HIV treatment were: concerns about drug tolerability/ side effects (overall 34.6%, France 39.1%, Germany 34.6%, Italy 27.6%, and UK 37.9%); concerns about long-term toxicities (overall 26.2%, France 39.1%, Germany 26.9%, Italy 24.1%, and UK 17.2%), as well as concerns about drugdrug interactions (overall 16.8%, France 13.0%, Germany 26.9%, Italy 17.2%, and UK 10.3%). Averaged across all ART regimen types, the percentage of PLHIV in the Unmet Needs Study who indicated that they needed monitoring when taking other medications with their ART was 5.8%, 15.9%, and 24.1% among those with none, 1, or ≥2 non-HIV comorbidities, respectively. Within the Positive Perspectives Survey, overall prevalence of polypharmacy was 38.8% (France 41.9%,Germany 24.2%, Italy 40.8%, and UK 48.0%). Compared to those without polypharmacy, those reporting polypharmacy had lower odds of reporting viral suppression (adjusted odds ratio, AOR=0.40) and optimal overall health (AOR=0.65); they were however more likely to be worried about taking more medicines as they grew older (AOR=2.15), and to be more concerned how their ART might affect other medicines they took (AOR=2.35) (all p<0.05). Conclusions A significant unmet need remains for PLHIV relating to co-management of comorbidities and associated challenges such as polypharmacy. Polypharmacy was associated with suboptimal self-rated health and concerns about the risk of long-term negative impacts from ART intake. Holistic care that provides simplified regimens to medically complex patients can help improve treatment outcomes.